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Sensory Function

This document provides guidance on performing a neurological examination, including: 1) Testing various sensory modalities like pain, temperature, light touch, vibration, and proprioception. 2) Evaluating deep tendon reflexes at key spinal levels and grading responses. 3) Assessing coordination and balance through tests of cerebellar function like finger-to-nose, heel-to-knee, and Romberg's test. 4) Looking for signs like clonus that can localize lesions in the nervous system.

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Fahra Fadhilla
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34 views

Sensory Function

This document provides guidance on performing a neurological examination, including: 1) Testing various sensory modalities like pain, temperature, light touch, vibration, and proprioception. 2) Evaluating deep tendon reflexes at key spinal levels and grading responses. 3) Assessing coordination and balance through tests of cerebellar function like finger-to-nose, heel-to-knee, and Romberg's test. 4) Looking for signs like clonus that can localize lesions in the nervous system.

Uploaded by

Fahra Fadhilla
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Sensory Function

• Fatigues quickly
– Efficiency
– Special attention to areas of:
• Symptomology
• Motor or reflex abnormalities
• Trophic changes
– Confirm with repeat testing!!
• Patterns of testing:
– Symmetrical
– Distal vs. proximal: scattered stimuli
– Vary pace
Sensory Function Testing
• Look for abnormality
– map out boundaries in detail
• Source of lesion
• Distribution of sensory abnormalities
and kinds of sensations affected
• +/- motor/reflex abnormality
• Demonstrate to patient before testing
Spinothalamic Tract

• Pain and temperature


• Crude touch (light touch
without localization)
• Fibers cross & pass
upward into thalamus
Pain Sensation
• Sharp safety pin or other tool
• Demonstrate sharp & dull
• Test by:
– Alternating sharp & dull w/ pt’s eyes closed
• Ask patient:
– Sharp or dull?
– Does this feel same as this?
– Lightest pressure needed - do not draw blood
Temperature
• Often omitted if pain sensation normal
• Two test tubes
– filled with hot & cold water
– or tuning fork heated or cooled by water
Light Touch
• Wisp of cotton
• Touch lightly -
avoid pressure
• Ask patient:
– To respond when
touch is felt
– Compare one
area with another
Posterior Columns
• Position and
vibration
• Fine touch
• Synapse in
medulla,
cross &
continue on
to thalamus
Vibratory Sense

• 128 or 256 Hz
Tuning fork
• If impaired,
proceed
proximally
Proprioception

Grasp toe by
sides - pull
away from
other toes
Demonstrate
“up” &
“down”
Tactile Localization
• Have pt close
eyes
• Touch pt on R
cheek & L arm
• Ask patient
where touch
was felt
Discriminative Sensations
• Stereognosis, graphesthesia, two-point
discrimination
• Test ability of sensory cortex to correlate,
analyze, & interpret sensations
• Dependent on touch & position sense
• Screen first with stereognosis - proceed to
other methods if indicated
Stereognosis
• Ability to identify an
object by feeling it
• Place familiar object in
patient’s hand & ask
patient to identify it
• Normally patient
manipulates it skillfully &
identifies it correctly
Graphesthesia

• Perform if inability
to manipulate
object
• Ability to identify
numbers written in
hand
• Use patient’s
orientation
Two-Point Discrimination

• Touch two places


simultaneously
• Alternate stimuli
• Avoid pain
• Determine distance
Spinal Reflexes: DTRs
• Segmental levels of DTRs:
– Supinator reflex C5, 6
– Biceps reflex C5, 6
– Triceps reflex C6, 7
– Abdominal reflexes - upper T8, 9, 10
– - lower T 10, 11, 12
– Knee (Patellar) L2, 3, 4
– Plantar responses L5, S1
– Achilles reflex S1 primarily
Deep Tendon Reflexes: Grading
Grade DTR Response
4+ Very brisk, hyperactive, with
clonus
3+ Brisker than average, slightly
hyperreflexic
2+ Average, expected response;
normal
1+ Somewhat diminished, low
normal
0 No response, absent
Reflex Hammer - Incorrect Usage
Jendrassik’s Maneuver

• Reinforcement
technique
• Upper extremities
– clench teeth
– squeeze thigh
• Lower extremities
– lock fingers and pull
one against the other
Biceps Reflex

C5,C6
Elbow Flexion
Triceps Reflex

C6, C7, C8
Elbow Extension
Brachioradialis Reflex
C5, C6
Forearm semiflexion/semipronation
(NO wrist/hand flexion)
Patellar Reflex

L2, L3, L4
Knee Extension
Achilles Reflex
S1, S2
Ankle Plantar Flexion
Plantar Reflex

L5, S1, S2 Babinski Sign


Abdominal Reflexes

T8, T9, T10:


ABOVE umbilicus
T10, T11, T12:
BELOW umbilicus
Anal Reflex
• Superficial reflex
• Loss of anal reflex suggests lesion of S2,3,4
reflex arc
• Possible lesion of cauda equina
Clonus

• Rhythmic Oscillation

• Flexion/Extension

• UMN Lesion
Cerebellar Function
• Requires • Assessed by:
integration of: – Rapid alternating
– Motor system movements
– Cerebellar system – Finger-to-Nose /
– Vestibular system Heel-to-Knee Test
– Sensory system – Romberg’s Test
– Gait
Finger-to-Nose Test
• Finger-to-nose
with moving
target

• Stationary
finger-to-nose
with eyes closed
Heel-to-Knee Test
Rapid Alternating Movements

• First with hands


• Repeat with feet
• Diadochokinesia = ability to perform RAM
• Dysdiadochokinesis = slow, irregular, clumsy
movements
Station, Stance & Romberg’s Test
• Station & Stance
– Pt stand with feet together
– First, eyes open
• Romberg Test
– Then, close eyes
– If okay with eyes open, but sways
w/ eyes closed = + Romberg
– Mainly tests position sense
• Vision can compensate for loss of
position sense
Pronator Drift

• Often performed in
conjunction with
Romberg test

• Pronator drift
– Muscular strength
– Coordination
– Position sense

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